ECMO Patient Monitoring and Assessment 3

Question 1

What does a persistently elevated lactate during ECMO most commonly indicate?

Accepted Answer

Insufficient systemic oxygen delivery or utilization

Answer

Elevated lactate (>2 mmol/L) persisting on ECMO reflects ongoing tissue hypoxia or impaired lactate clearance, signaling inadequate support.

Question 2

During ECMO, urine output less than 0.5 mL/kg/hr for more than 2 hours suggests:

Accepted Answer

Acute kidney injury or inadequate perfusion

Answer

Oliguria below 0.5 mL/kg/hr is a standard marker of inadequate renal perfusion or acute kidney injury requiring prompt assessment of ECMO flows and hemodynamics.

Question 3

Which hemodynamic finding on a pulmonary artery catheter would indicate left ventricular distension in a VA-ECMO patient?

Accepted Answer

High PCWP with low cardiac output

Answer

Elevated PCWP with low native cardiac output in VA-ECMO indicates LV distension from afterload mismatch, potentially requiring LV unloading.

Question 4

How frequently should ACT (activated clotting time) be checked during routine ECMO management?

Accepted Answer

Every 1-2 hours

Answer

ACT is typically monitored every 1-2 hours during ECMO to maintain anticoagulation within the target range (usually 180-220 seconds) and balance thrombosis vs. bleeding risk.

Question 5

A 'chatter' or 'flutter' in the ECMO tubing during a drainage phase typically signals:

Accepted Answer

Venous inflow obstruction or hypovolemia

Answer

Tubing chatter occurs when the centrifugal pump generates intermittent high negative pressure due to inadequate venous return, indicating hypovolemia or cannula obstruction.

ECMO - Extracorporeal Membrane Oxygenation Practice Test

ECMO - Extracorporeal Membrane Oxygenation Practice Test

ECMO Patient Monitoring and Assessment 3